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Checklist for Infection Control Concerns When Reopening Healthcare Facilities Closed Due to Extensive Water and Wind Damage

Prior to opening a healthcare facility that has undergone extensive water and wind damage, inspections need to be conducted to determine if the building is salvageable. If the decision is made to proceed with recovery and remediation, building and life safety inspections must be completed before any restoration work is done to the facility. Parts I – IV describe those activities that need to be completed. Parts V – VII provide guidance for infection control review of facilities to be done before the hospital can reopen.

Prior to opening any portion of a facility such as emergency rooms or clinics, adequate support services need to be available to provide quality care in a safe environment. Contracting with outside services could be considered.

Certification for occupancy must be obtained prior to reopening the facility. Regulations regarding healthcare facility certification and licensing differ from state to state. Refer to specific state and local government resources for more information.

I. Safety Evaluation

The following should be evaluated by facilities experts:

structural integrity and missing structural items

assessment of hidden moisture

electrical system damage, including high voltage, insulation, and power integrity

water distribution system damage

sewer system damage

fire emergency systems damage

air handling system damage

medical waste and sharps disposal system

II. Water Removal

Water should be removed as soon as possible once the safety of the structure has been verified.

pump out standing water

wet vacuum residual wetness from floors, carpets and hard surfaces

clean wet vacuums after use and allow to dry

III. Water Damage Assessment and Mold Remediation

open the windows in the damaged areas of the building during remediation

remove porous items that have been submerged or have visible mold growth or damage

minimize dispersion of mold spores by covering the removed items and materials with plastic sheeting (dust-tight chutes leading to dumpsters outside the building may be helpful)

dispose these items as construction waste

seal off the ventilation ducts to and from the remediation area and isolate the work area from occupied spaces, if the building is partially occupied

scrub and clean hard surfaces with detergents to remove evident mold growth (If a biocide is used, follow manufacturer’s instructions for use and ventilate the area. Do not mix chlorine-containing biocides with detergents or biocides containing ammonia.)

dry the area and remaining items and surfaces

evaluate the success of drying and look for residual moisture in structural materials (Moisture detection devices [e.g., moisture meters] or borescopes could be used in this evaluation.)

remove and replace structural materials if they cannot be dried out within 48 hours

or if patients who are receiving care in the reopened facility acquire infections that are potentially healthcare-associated and that may be attributed to Aspergillus spp. or other fungi, non-tubercular mycobacteria, Legionella, or other waterborne microorganisms above expected levels.

VII. Site Specific Check List for Selected Areas of the FacilityAttachment A

Area

Question

Yes

No

Comments

Laboratory Services

Can essential laboratory testing be provided?

blood-gases and co-oximetry

electrolytes

hepatic and basic metabolic profiles

hemograms and coagulation studies

Can microbiological, toxicological, and serologic testing be performed or sent to a referral laboratory?

Is emergency power available to operate equipment and safety systems and/or provide necessary ambient conditions?

Has essential equipment been inspected for damage and heat/humidity exposure and manufacturers contacted for guidance on repair, cleaning, and disinfection?

Have damaged or contaminated reagents and supplies been replaced?

Have biologic safety cabinets been cleaned, disinfected and recertified?

Central sterile processing area

Have all autoclaves been inspected for damage and manufacturers contacted for guidance on repair, cleaning, and disinfection?

Does the steam system meet AAMI standards?

Have mechanical and biological indicator tests been performed on sterilization equipment?

Were stored sterile supplies compromised? Have they been reprocessed or replaced?

Have the washers, instrument disinfection, and ultrasonic equipment been tested for performance?

Operating Suite

Has there been any damage to the sealed flooring and ceilings?

Do sterile supplies need reprocessing?

Have the autoclaves been inspected and undergone mechanical and biological indicator testing?

Has an evaluation for electrical hazards been conducted?

Are the scrub sinks functioning properly?

Are there enough air exchanges per hour?

Have all air filters been changed?

Pharmacy

Have damaged or contaminated medications and solutions been replaced?

Are refrigerators for medication storage at the proper temperature?

Has the medication compounding area been thoroughly disinfected?

Has the admixture hood been recertified and filters changed?

Respiratory Therapy, Bronchoscopy, Pulmonary Function

Has the equipment processing equipment been inspected?

Was there any damage to equipment? Has it been repaired and certified?

Have damaged or contaminated medications and solutions been replaced?

Radiology, Radiation Oncology

Has all equipment been inspected and disinfected?

Have all damaged or contaminated medications and supplies been replaced?

Has damaged equipment been recertified?

Has radioactive materials been assessed and contained?

All Patient Care Areas

Has all furniture and equipment been inspected, repaired, and disinfected?

Has porous furniture that was wet been discarded?

Were mattresses discarded if they have been under water or wet?

Have all linens been laundered?

Have medications and supplies that were damaged or contaminated been discarded?

Are medical gas and suction systems operable?

Have ice machines been flushed, cleaned, and disinfected?

Are medical gas and suction systems including air lines operable and cleaned?

Emergency Department

Have stretchers and exam tables been inspected, repaired, and disinfected?

Have cardiac monitors been recertified?

Has the trauma room flooring been damaged? Has it been repaired or replaced?

Have support service areas in the ED (radiology, lab) been inspected in the same manner as the larger department?

Is public access to the emergency room safe for entry?

Intensive Care Units/Burn Units

Have cardiac monitors been recertified?

Have whirlpool and physiotherapy area been repaired and disinfected?

Laundry Processing Area

Has all laundry equipment been inspected for damage and manufacturers contacted for guidance on repair, cleaning, and disinfection?

Have containers for stored laundry chemicals and dispensing equipment been inspected?

Food Service

Has stored food (dry and canned goods) been inspected for damage or contamination and discarded if it is unsafe to eat?